Frontline: The Schizophrenic Person and the Benefits of the Psychotherapies—Seeking a PORT in the Storm

Current views on the treatment of schizophrenia usually ignore psychodynamic approaches, their seemingly outmoded texts soon to be filed away in the library's section on the history of psychiatry. We seem to know schizophrenia to be a brain disease, requiring biologic treatments. We read that insight-fostering approaches are too dangerous even if the patient is medicated. Enforcing drug compliance seems a central objective of psychoeducation. Psychodynamic papers too often are discounted as anecdotal and nonscientific, or as mere efforts at self-promotion on the part of the authors. Psychiatric residents often refuse to grapple with these papers because they don't understand the jargon. We hear repeatedly of heads of programs telling their staffs, “Don't even mention psychotherapy.” Psychiatrists ask members of the supposed treatment team, “Why are you bothering to talk to X? We are medicating him/her. That's enough.”

Are all psychiatrists, or perhaps all mental health professionals, convinced that (a)schizophrenia is a brain disease whose etiology will soon be defined, (b) we now have specific medications that treat the illness, and (c) these newer medications are safe, preventing long-term sequelae such as tardive dyskinesia? But what if the blue frontal lobes we see in PET scans of people suffering from schizophrenia, along with the changes in limbic and related pathways, turn out to reflect the consequence of chronic severe stress, and are adaptations to the organismic panic of the original psychotic storm? What if we can show clear pinking up of the frontal lobes over the course of psychodynamic treatment? We still lack animal models, biological markers, or etiological evidence of this as a disease. While the proofs and documentations for our modern biological thesis are not yet available, even given our powerful new scientific instruments, those of us who advocate for a psychodynamic approach are told we need to prove this treatment is not dangerous, to present